RESUMEN
Since the introduction of the 4th generation silicone gel implants, number of breast augmentation using so-called 'cohesive gel' implants has increased rapidly. Still, implant rupture remains the most annoying complication of breast implant surgery. Recently, magnetic resonance image (MRI) is used as the gold standard in diagnosis of implant rupture. We experienced patients diagnosed as implant rupture with MRI finding, whose implants were found not to be ruptured, but only folded. These patients underwent breast augmentation with cohesive gel and presented to our center with complaint of breast asymmetry and texture-related discomfort. We recommended MRI imaging for diagnosis and the result of radiological diagnosis were 'rupture of implant'. After surgical exploration, we found intact implants without rupture. They were severely folded and fixed with folded form. With our experience, we conclude that cohesive gel implants, due to their more cohesive and form-stable characteristics, sometimes tend to fold and fix in stable folded form and in such cases, MRI image can be similar with the image of ruptured implant. Therefore, in diagnosis of cohesive gel rupture, surgeons should consider both radiologic finding and physical examination carefully before the decision of exploration.